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Steenkamp MM, Schlenger WE, Corry N, Henn-Haase C, Qian M, Li M, Horesh D, Karstoft KI, Williams C, Ho CL, Shalev A, Kulka R, Marmar C. Predictors of PTSD 40 years after combat: Findings from the National Vietnam Veterans longitudinal study. Depress Anxiety 2017; 34:711-722. [PMID: 28489300 DOI: 10.1002/da.22628] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few studies have longitudinally examined predictors of posttraumatic stress disorder (PTSD) in a nationally representative sample of US veterans. We examined predictors of warzone-related PTSD over a 25-year span using data from the National Vietnam Veterans Longitudinal Study (NVVLS). METHODS The NVVLS is a follow-up study of Vietnam theater veterans (N = 699) previously assessed in the National Vietnam Veterans Readjustment Study (NVVRS), a large national-probability study conducted in the late 1980s. We examined the ability of 22 premilitary, warzone, and postmilitary variables to predict current warzone-related PTSD symptom severity and PTSD symptom change in male theater veterans participating in the NVVLS. Data included a self-report Health Questionnaire survey and a computer-assisted telephone Health Interview Survey. Primary outcomes were self-reported PTSD symptoms assessed by the PTSD Checklist for DSM-5 (PCL 5) and Mississippi PTSD Scale (M-PTSD). RESULTS Predictors of current PTSD symptoms most robust in hierarchical multivariable models were African-American race, lower education level, negative homecoming reception, lower current social support, and greater past-year stress. PTSD symptoms remained largely stable over time, and symptom exacerbation was predicted by African-American race, lower education level, younger age at entry into Vietnam, greater combat exposure, lower current social support, and greater past-year stressors. CONCLUSIONS Findings confirm the robustness of a select set of risk factors for warzone-related PTSD, establishing that these factors can predict PTSD symptom severity and symptom change up to 40 years postdeployment.
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Affiliation(s)
- Maria M Steenkamp
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | | | | | - Clare Henn-Haase
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Meng Qian
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Meng Li
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Danny Horesh
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Karen-Inge Karstoft
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | | | | | - Arieh Shalev
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | | | - Charles Marmar
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
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Ho CL, Schlenger WE, Kulka RA, Marmar CR. The influence of different criteria for establishing optimal cutoff scores on performance of two self-report measures for warzone PTSD. Psychol Assess 2016; 29:232-237. [PMID: 27183044 DOI: 10.1037/pas0000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been regarded as a signature injury of war and elevated to one of the major behavioral health problems faced by military service members and veterans deployed to warzones. In PTSD diagnosis, self-report measures have often been used with a cutoff score to identify those with an elevated likelihood of having PTSD prior to conducting a second-tier diagnostic interview. With an attempt to guide the selection of cutoffs in self-report PTSD measures for various purposes, this study examined how five common criteria for establishing an optimal cutoff influenced the performance of self-report measures for warzone PTSD in relation to the Clinician Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and whether the influence differed for the PTSD Checklist for DSM-5 and the Mississippi Scale for Combat-Related PTSD. Using a probability sample of Vietnam theater veterans in the National Vietnam Veterans Longitudinal Study, results showed that in both self-report measures, the Youden Index criterion yielded the optimal cutoff that led to better test performance. (PsycINFO Database Record
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Affiliation(s)
- Chia-Lin Ho
- Department of Business Administration, Shih-Hsin University
| | | | | | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU Langone Medical Center
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Schlenger WE, Mulvaney-Day N, Williams CS, Kulka RA, Corry NH, Mauch D, Nagler CF, Ho CL, Marmar CR. PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War. Psychiatr Serv 2016; 67:543-50. [PMID: 26725289 DOI: 10.1176/appi.ps.201400576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. METHODS Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. RESULTS Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. CONCLUSIONS Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.
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Affiliation(s)
- William E Schlenger
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Norah Mulvaney-Day
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Christianna S Williams
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Richard A Kulka
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Nida H Corry
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Danna Mauch
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Caryn F Nagler
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Chia-Lin Ho
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Charles R Marmar
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
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Schlenger WE, Corry NH, Williams CS, Kulka RA, Mulvaney-Day N, DeBakey S, Murphy CM, Marmar CR. A Prospective Study of Mortality and Trauma-Related Risk Factors Among a Nationally Representative Sample of Vietnam Veterans. Am J Epidemiol 2015; 182:980-90. [PMID: 26634285 DOI: 10.1093/aje/kwv217] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022] Open
Abstract
Because Vietnam veterans comprise the majority of all living veterans and most are now older adults, the urgency and potential value of studying the long-term health effects of service in the Vietnam War, including effects on mortality, is increasing. The present study is the first prospective mortality assessment of a representative sample of Vietnam veterans. We used one of the longest follow-up periods to date (spanning older adulthood) and conducted one of the most comprehensive assessments of potential risk factors. Vital status and cause of death were ascertained for the 1,632 veterans who fought in the Vietnam theater (hereafter referred to as theater veterans) and for 716 Vietnam War-era veterans (hereafter referred to as era veterans) who participated in the National Vietnam Veterans Readjustment Study (1987-2011). As of April 2011, 16.0% (95% confidence interval: 13.1, 19.0) of all Vietnam veterans who were alive in the 1980s were deceased. Male theater veterans with a high probability of posttraumatic stress disorder (PTSD) were nearly 2 times more likely to have died than were those without PTSD, even after adjustment for sociodemographic and other characteristics. A high level of exposure to war zone stress was independently associated with mortality for both male and female theater veterans after adjustment for sociodemographic characteristics, PTSD, and physical comorbid conditions. Theater veterans with a high level of exposure to war zone stress and a high probability of PTSD had the greatest mortality risk (adjusted hazard ratio = 2.34, 95% confidence interval: 1.24, 4.43).
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Schlenger WE, Corry NH, Kulka RA, Williams CS, Henn-Haase C, Marmar CR. Design and methods of the national Vietnam veterans longitudinal study. Int J Methods Psychiatr Res 2015; 24:186-203. [PMID: 26096554 PMCID: PMC6878456 DOI: 10.1002/mpr.1469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/20/2014] [Accepted: 06/27/2014] [Indexed: 11/06/2022] Open
Abstract
The National Vietnam Veterans Longitudinal Study (NVVLS) is the second assessment of a representative cohort of US veterans who served during the Vietnam War era, either in Vietnam or elsewhere. The cohort was initially surveyed in the National Vietnam Veterans Readjustment Study (NVVRS) from 1984 to 1988 to assess the prevalence, incidence, and effects of post-traumatic stress disorder (PTSD) and other post-war problems. The NVVLS sought to re-interview the cohort to assess the long-term course of PTSD. NVVLS data collection began July 3, 2012 and ended May 17, 2013, comprising three components: a mailed health questionnaire, a telephone health survey interview, and, for a probability sample of theater Veterans, a clinical diagnostic telephone interview administered by licensed psychologists. Excluding decedents, 78.8% completed the questionnaire and/or telephone survey, and 55.0% of selected living veterans participated in the clinical interview. This report provides a description of the NVVLS design and methods. Together, the NVVRS and NVVLS constitute a nationally representative longitudinal study of Vietnam veterans, and extend the NVVRS as a critical resource for scientific and policy analyses for Vietnam veterans, with policy relevance for Iraq and Afghanistan veterans.
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Affiliation(s)
| | | | | | | | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
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Brown LK, DiClemente R, Crosby R, Fernandez MI, Pugatch D, Cohn S, Lescano C, Royal S, Murphy JR, Silver B, Schlenger WE. Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure associated with not using condoms. Public Health Rep 2008; 123:601-7. [PMID: 18828415 DOI: 10.1177/003335490812300510] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. METHODS We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. RESULTS Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. CONCLUSIONS Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.
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Affiliation(s)
- Larry K Brown
- Rhode Island Hospital, Coro West, Ste. 204, 1 Hoppin St., Providence, RI 02903, USA.
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Lescano CM, Houck CD, Brown LK, Doherty G, DiClemente RJ, Fernandez MI, Pugatch D, Schlenger WE, Silver BJ. Correlates of heterosexual anal intercourse among at-risk adolescents and young adults. Am J Public Health 2008; 99:1131-6. [PMID: 19008522 DOI: 10.2105/ajph.2007.123752] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to learn what factors are associated with anal intercourse among adolescents and young adults. We examined demographic, behavioral, relationship context, attitudinal, substance use, and mental health correlates of recent heterosexual anal intercourse among adolescents and young adults who reported engaging in recent unprotected sex. METHODS Among 1348 at-risk adolescents and young adults aged 15 to 21 years in 3 US cities, we assessed sexual risk behavior with each sexual partner in the past 90 days. Data were collected from 2000 to 2001. RESULTS Recent heterosexual anal intercourse was reported by 16% of respondents. Females who engaged in anal intercourse were more likely to be living with a sexual partner, to have had 2 or more partners, and to have experienced coerced intercourse. For males, only a sexual orientation other than heterosexual was a significant predictor of engaging in heterosexual anal intercourse. CONCLUSIONS Our findings document the prevalence of heterosexual anal intercourse among adolescents and young adults who had recent unprotected sex. Among females, the variables associated with anal intercourse relate to the context and power balance of sexual relationships. Different influences for males and females suggest different foci for interventions.
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Affiliation(s)
- Celia M Lescano
- Bradley/Hasbro Children's Research Center, Providence, RI 02903, USA.
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Abstract
In recent years, controversy concerning the psychological consequences of service in the Vietnam war has rearisen. In this article, the Co-Principal Investigators of the National Vietnam Veterans Readjustment Study (NVVRS) provide a perspective on new findings reported by B. P. Dohrenwend et al. (2006) that addresses criticisms of the NVVRS PTSD (posttraumatic stress disorder) prevalence findings, and on a perspective that was provided by R. J. McNally (2006) in an accompanying commentary. They find that Dohrenwend et al.'s study, which evaluated empirically a variety of the critics' alternative explanations and found little support for any of them, represents a landmark contribution to the trauma field. However, they found that McNally's commentary misrepresented the history and context of the NVVRS, and then misinterpreted Dohrenwend et al.'s findings and their importance.
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Wu LT, Pilowsky DJ, Schlenger WE, Galvin DM. Misuse of methamphetamine and prescription stimulants among youths and young adults in the community. Drug Alcohol Depend 2007; 89:195-205. [PMID: 17257780 PMCID: PMC2063507 DOI: 10.1016/j.drugalcdep.2006.12.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 12/15/2006] [Accepted: 12/16/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gender differences in the prevalence and characteristics of misuse of methamphetamine (meth) and prescription stimulants were examined in a representative US sample of youths and young adults aged 16-25 (N=24,409). METHODS Stimulant misusers were categorized into three mutually exclusive subgroups: meth users only, meth and prescription stimulant users, and prescription stimulant users only (e.g., Benzedrine, Ritalin, or Dexedrine). Multinominal logistic regression analyses identified the characteristics associated with misuse of meth and prescription stimulants. RESULTS About 1 in 10 youths reported any misuse of stimulants in their lifetime. Prescription stimulant misuse occurred earlier and was more frequent than meth misuse. About 47% of meth misusers also reported prescription stimulant misuse. Among misusers of meth and prescription stimulants, males were more likely than females to misuse methylphenidate (82% versus 65%) but were less likely to misuse diet pills or amphetamines (37% versus 49%). Multinominal logistic regression analyses indicated that all subgroups of lifetime stimulant misuse were associated with past year substance abuse. The characteristics of meth misusers differed slightly from prescription stimulants misusers. CONCLUSIONS Multidrug use is common among stimulant misusers. Parents should be informed about the risk of prescription stimulant misuse by their youths.
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Affiliation(s)
- Li-Tzy Wu
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 2213 Elba Street, Civitan Building, Room 240 Duke University Medical Center, Durham, NC 27710, USA.
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Wu LT, Pilowsky DJ, Schlenger WE, Hasin D. Alcohol use disorders and the use of treatment services among college-age young adults. Psychiatr Serv 2007. [PMID: 17287375 DOI: 10.1176/appi.ps.58.2.192] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18-22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously. METHODS Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health. RESULTS Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling. CONCLUSIONS College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, P.O. Box 17969, Durham, NC 27715, USA.
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Abstract
OBJECTIVES This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18-22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously. METHODS Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health. RESULTS Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling. CONCLUSIONS College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, P.O. Box 17969, Durham, NC 27715, USA.
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Wu LT, Schlenger WE, Galvin DM. Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths. Drug Alcohol Depend 2006; 84:102-13. [PMID: 16483730 PMCID: PMC1609189 DOI: 10.1016/j.drugalcdep.2006.01.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 12/19/2005] [Accepted: 01/04/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N=19,084). METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs. RESULTS Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence. CONCLUSIONS Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.
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Affiliation(s)
- Li-Tzy Wu
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC, P.O. Box 17969, Durham, NC 27715, USA.
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Abstract
This article provides an overview of the use of the Internet for conducting studies after terrorist attacks and other large-scale disasters. We begin with a brief summary of the scientific and logistical challenges of conducting such research, followed by a description of some of the most important design features that are required to produce valid findings. We then describe one approach to Internet surveys that, although not perfect, addresses many of the challenges well. We close with some thoughts about how the Internet-based methods available today are likely to develop further in coming years.
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Schlenger WE, Williams RL, Blitstein JL. Iatrogenic risk of screening for youth suicide. JAMA 2005; 294:2578-9; author reply 2579-80. [PMID: 16304069 DOI: 10.1001/jama.294.20.2578-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Houck CD, Lescano CM, Brown LK, Tolou-Shams M, Thompson J, Diclemente R, Fernandez MI, Pugatch D, Schlenger WE, Silver BJ. "Islands of Risk": subgroups of adolescents at risk for HIV. J Pediatr Psychol 2005; 31:619-29. [PMID: 16120764 DOI: 10.1093/jpepsy/jsj067] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To use cluster analysis to determine profiles of adolescents at risk for HIV. METHODS Adolescents 15-21 years old (N = 1153) with a history of unprotected sex were assessed in five domains of risk (unprotected sex, alcohol/marijuana use, other drug use, mental health crises, and arrest/school dropout) as well as demographic, contextual, and behavioral variables. RESULTS Cluster analysis revealed separate three-cluster solutions for males and females. Among males, clusters were characterized by (a) mental health crises and unprotected sex, (b) alcohol/marijuana use and unprotected sex, and (c) lower risk. Among females, clusters were distinguished by (a) unprotected sex, (b) substance use and mental health crises, and (c) lower risk. Cluster membership was associated with secondary variables related to sexual risk. CONCLUSIONS Even within populations of high-risk adolescents, subgroups exist for which specific risk factors co-occur, particularly unprotected sex, mental health crises, and substance use. These patterns suggest that effective HIV prevention interventions may need to target the association between mental health and/or substance abuse with sexual risk for some adolescents.
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Abstract
PURPOSE We examined the patterns and correlates of nitrite inhalant use among adolescents aged 12 to 17 years. METHODS Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Logistic regression was used to identify the characteristics associated with nitrite inhalant use. RESULTS Among adolescents aged 12 to 17 years, 1.5% reported any lifetime use of nitrite inhalants. The prevalence of lifetime nitrite inhalant use increased to 12% and 14% among adolescents who were dependent on alcohol and any drug in the past year, respectively. Many nitrite inhalant users used at least three other types of inhalants (68%) and also met the criteria for alcohol (33%) and drug (35%) abuse or dependence. Increased odds of nitrite inhalant use were associated with residing in nonmetropolitan areas, recent utilization of mental health services, delinquent behaviors, past year alcohol and drug abuse and dependence, and multi-drug use. CONCLUSIONS Adolescents who had used nitrite inhalants at least once in their lifetime tend to engage in delinquent activities and report co-occurring multiple drug abuse and mental health problems in the past year.
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Affiliation(s)
- Li-Tzy Wu
- RTI International, Research Triangle Park, North Carolina 27709-2194, USA.
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Wu LT, Pilowsky DJ, Schlenger WE. High prevalence of substance use disorders among adolescents who use marijuana and inhalants. Drug Alcohol Depend 2005; 78:23-32. [PMID: 15769554 DOI: 10.1016/j.drugalcdep.2004.08.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Revised: 08/18/2004] [Accepted: 08/19/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND We examined the association between the use of inhalants, marijuana, and other drugs and recent DSM-IV substance use disorders among adolescents aged 12-17 years. METHODS Data were drawn from 2000 to 2001 National Household Surveys on Drug Abuse. Adolescents aged 12-17 years who reported having ever used an illicit drug in their lifetime were categorized into four mutually exclusive groups: inhalant users (16%), marijuana users (53%), inhalant and marijuana users (16%), and other drug users (15%). Logistic regression models were used to estimate associations with recent substance use diagnoses among lifetime adolescent drug users (N=10,180). RESULTS We found that 31% of lifetime drug users reported having never used marijuana. One half of these atypical drug users were predominantly nonmedical users of pain relievers. Adolescents who used inhalants or other drugs but not marijuana were least likely to report multidrug use. Adolescents who reported using both inhalants and marijuana were most likely to use three or more classes of drugs (73%) and to receive a diagnosis of past year alcohol (35%) and drug (39%) abuse or dependence. CONCLUSIONS Our study findings suggest that among lifetime adolescent drug users, those who use both inhalants and marijuana are at very high risk for alcohol and drug use disorders.
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Affiliation(s)
- Li-Tzy Wu
- Center for Risk Behavior and Mental Health Research, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
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Abstract
OBJECTIVE To examine the patterns of inhalant use and correlates of the progression from inhalant use to abuse and dependence among adolescents aged 12 to 17. METHOD Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Multinominal logistic regression was used to identify the characteristics associated with progression to inhalant abuse and dependence. RESULTS Inhalant use was common among the studied adolescents. Among adolescents aged 12 to 17, 0.4% met DSM-IV inhalant abuse or dependence criteria in the past year. Inhalant abuse and dependence affected adolescents regardless of gender, age, race/ethnicity, and family income. The progression from inhalant use to abuse or dependence was related to early first use, use of multiple inhalants, and weekly inhalant use. Adolescents with inhalant use disorders reported coexisting multiple drug abuse and dependence, mental health treatment, and delinquent behaviors. CONCLUSIONS Adolescents with an inhalant use disorder may represent a subgroup of highly troubled youths with multiple vulnerabilities. Because early use is associated with progression to abuse and dependence, prevention programs should target elementary school-age children.
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Affiliation(s)
- Li-Tzy Wu
- RTI International, Research Triangle Park, NC 27709, USA.
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Abstract
OBJECTIVE This study examined the correlates of injection drug use (IDU) in a community sample of psychostimulant users. Factors related to the cessation of illicit drug use and substance abuse service utilization were also determined among a subsample of stimulant users who reported IDU. METHOD The study sample consisted of 3408 lifetime psychostimulant users from the National Household Survey on Drug Abuse. Logistic regression procedures were used to estimate independent associations of correlates of IDU. RESULTS Approximately one in seven lifetime stimulant users reported IDU in their lifetime. Stimulant users with a lifetime history of IDU were more likely than those who did not inject to be African-American, not have received a high school diploma, have a history of multiple drug use, and report an onset of stimulant use before age 18. Among recent stimulant users, being aged 26 or older, using stimulants at least weekly, and getting drunk in the past year were associated with increased odds of recent IDU. Only one-half of all injection drug users reported having ever used substance abuse services. Cessation of illicit drug use among injectors with a history of stimulant use is common (44%). CONCLUSIONS Further studies should clarify the natural history of IDU among stimulant users, including the cessation of drug use without participating in substance abuse treatment services.
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Affiliation(s)
- Li-Tzy Wu
- Center for Risk Behavior and Mental Health Research, RTI International, P.G. Box 12194, Research Triangle Park, NC 27709-2194, USA.
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Abstract
Four years of data from the National Household Survey on Drug Abuse were combined to examine the characteristics of underinsurance in a sample of privately insured Americans aged 18 to 64. Among these adults, 38 percent (45 million) reported not having behavioral health coverage or not knowing their coverage. Young adults aged 18 to 25, Hispanics, Asians, adults in the lowest income level, and less educated adults were more likely to be underinsured. Untreated addictive and psychiatric problems are costly to society. Underinsurance among socially disadvantaged subgroups deserves greater attention from researchers and policy makers.
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Affiliation(s)
- Li-Tzy Wu
- Center for Risk Behavior and Mental Health Research at RTI International, Research Triangle Park, North Carolina 27709, USA.
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Broner N, Lattimore PK, Cowell AJ, Schlenger WE. Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study. Behav Sci Law 2004; 22:519-541. [PMID: 15282838 DOI: 10.1002/bsl.605] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.
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Affiliation(s)
- Nahama Broner
- Crime, Justice Policy, and Behavior Program, Health, Social and Economic Research, RTI International, 915 Broadway, Suite 1200, New York, NY 10010, USA.
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Wu LT, Kouzis AC, Schlenger WE. Substance use, dependence, and service utilization among the US uninsured nonelderly population. Am J Public Health 2003; 93:2079-85. [PMID: 14652338 PMCID: PMC1283119 DOI: 10.2105/ajph.93.12.2079] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.
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Affiliation(s)
- Li-Tzy Wu
- RTI International, Research Triangle Park, NC 12194, USA.
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Schlenger WE, Jernigan NE. Mental health issues in disasters and terrorist attacks. Ethn Dis 2003; 13:S3-89-93. [PMID: 14552462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Recent events make clear that those living in the United States are at risk of exposure to a variety of potentially traumatic events, ranging from sniper and terrorist attacks to a variety of natural disasters. This paper provides a broad overview of the most common psychological reactions that can be expected in the aftermath of such events, how primary care practitioners can identify such reactions in their patients, and actions those practitioners might take.
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Affiliation(s)
- William E Schlenger
- Center for Risk Behavior and Mental Health Research, Research Triangle Institute, Research Triangle Park, North Carolina 27709-2194, USA.
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Abstract
PURPOSE To examine the association between employment status and substance use among students aged 12 to 17 years. METHODS Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. RESULTS About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. CONCLUSIONS The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.
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Affiliation(s)
- Li Tzy Wu
- Center for Risk Behavior and Mental Health Ressearch, Research Triangle Institute, Research Triangle Park, North Carolina 27709-2194, USA.
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25
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Abstract
OBJECTIVE To examine the prevalence of psychostimulant dependence and the characteristics associated with nonmedical users' development of dependence. METHODS The study sample was drawn from the 1995 to 1998 National Household Surveys on Drug Abuse. Statistical analysis was conducted on a total of 1047 individuals aged 12 or older who reported nonmedical use of stimulants in the past year. Multiple multinomial logistic regression identified factors related to stimulant dependence and dependence problems. RESULTS Among all past year stimulant users, 19% met criteria for stimulant dependence in the past year, and an additional 16% reported having one to two dependence problems. Adjusting for demographics and drug use characteristics, female stimulant users were an estimated 2.6 times more likely than male users to develop dependence. Not only did the Western region of the United States have more recent stimulant users than other regions, its users also were more likely to meet criteria for dependence or experience dependence problems. Stimulant users who had increased odds of progressing into dependence were characterized by an early onset of stimulant use, coexisting multiple illicit drug use, and an onset of daily cigarette smoking between the ages of 13 and 17 years. CONCLUSIONS Gender differences in initial stimulant use and progression to dependence require further investigation, including contextual, cultural, or perceptual factors related specifically to the choice of drugs by females.
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Affiliation(s)
- Li-Tzy Wu
- Center for Risk Behavior and Mental Health Research, Research Triangle Institute, North Carolina 27709-2194, USA.
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Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, Thalji L, Dennis JM, Fairbank JA, Kulka RA. Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA 2002; 288:581-8. [PMID: 12150669 DOI: 10.1001/jama.288.5.581] [Citation(s) in RCA: 798] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The terrorist attacks of September 11, 2001, represent an unprecedented exposure to trauma in the United States. OBJECTIVES To assess psychological symptom levels in the United States following the events of September 11 and to examine the association between postattack symptoms and a variety of indices of exposure to the events. DESIGN Web-based epidemiological survey of a nationally representative cross-sectional sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief Symptom Inventory, administered 1 to 2 months following the attacks. SETTING AND PARTICIPANTS Sample of 2273 adults, including oversamples of the New York, NY, and Washington, DC, metropolitan areas. MAIN OUTCOME MEASURES Self-reports of the symptoms of PTSD and of clinically significant nonspecific psychological distress; adult reports of symptoms of distress among children living in their households. RESULTS The prevalence of probable PTSD was significantly higher in the New York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major metropolitan areas (3.6%), and the rest of the country (4.0%). A broader measure of clinically significant psychological distress suggests that overall distress levels across the country, however, were within expected ranges for a general community sample. In multivariate models, sex, age, direct exposure to the attacks, and the amount of time spent viewing TV coverage of the attacks on September 11 and the few days afterward were associated with PTSD symptom levels; sex, the number of hours of television coverage viewed, and an index of the content of that coverage were associated with the broader distress measure. More than 60% of adults in New York City households with children reported that 1 or more children were upset by the attacks. CONCLUSIONS One to 2 months following the events of September 11, probable PTSD was associated with direct exposure to the terrorist attacks among adults, and the prevalence in the New York City metropolitan area was substantially higher than elsewhere in the country. However, overall distress levels in the country were within normal ranges. Further research should document the course of symptoms and recovery among adults following exposure to the events of September 11 and further specify the types and severity of distress in children.
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Affiliation(s)
- William E Schlenger
- Center for Risk Behavior and Mental Health Research, Research Triangle Institute, PO Box 12194, Research Triangle Park, NC 27709, USA.
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Beals J, Manson SM, Shore JH, Friedman M, Ashcraft M, Fairbank JA, Schlenger WE. The prevalence of posttraumatic stress disorder among American Indian Vietnam veterans: disparities and context. J Trauma Stress 2002; 15:89-97. [PMID: 12013069 DOI: 10.1023/a:1014894506325] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.
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Affiliation(s)
- Janette Beals
- Department of Psychiatry, National Center for American Indian and Alaska Native Mental Health Research, University of Colorado Health Sciences Center, Denver 80220, USA.
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Jordan BK, Federman EB, Burns BJ, Schlenger WE, Fairbank JA, Caddell JM. Lifetime use of mental health and substance abuse treatment services by incarcerated women felons. Psychiatr Serv 2002; 53:317-25. [PMID: 11875226 DOI: 10.1176/appi.ps.53.3.317] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the lifetime use of alcohol, drug, and mental health treatment services by recently incarcerated women prison inmates. METHODS A total of 805 women entering a North Carolina prison for new felony charges in 1991 and 1992 were interviewed in person shortly after incarceration. The women were assessed for psychiatric disorders and lifetime use of substance abuse and mental health treatment services. Rates of service use were analyzed by inmate characteristics and were compared with rates for a sample of women in the community in North Carolina. RESULTS The majority of women inmates reported a history of using substance abuse services or mental health services or both. Those with psychiatric disorders and prison recidivists were the most likely to have used such services. Rates of service use were substantially higher for the inmates than for the women in the community, even when the effects of having a psychiatric or substance use disorder were controlled for. CONCLUSIONS Many of the incarcerated women in the study met lifetime criteria for alcohol, drug, and mental health disorders that were significantly related to their use of substance abuse and mental health treatment services. The majority of the inmates met criteria for a current disorder despite past treatment. Further research is needed to help in developing programs to reduce women inmates' alcohol, drug, and mental health problems.
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Affiliation(s)
- B Kathleen Jordan
- Research Triangle Institute, Research Triangle Park, North Carolina 27709-2194, USA.
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Abstract
Hispanic veterans are said to exhibit higher risk of developing posttraumatic stress disorder (PTSD) than veterans of other racial/ethnic backgrounds. This prediction is based largely on findings from the National Vietnam Veterans Readjustment Study (NVVRS; R. A. Kulka et al., 1990a, 1990b). This article first summarizes the findings of the NVVRS with regard to race/ethnicity and PTSD, and then it makes a careful assessment of both the external and the internal validity of these findings. Conceptual issues are addressed and, where possible, further analyses of the NVVRS data set are conducted to identify factors that account for ethnic differences in rates of the disorder. Possible mediators of the effects of Hispanic ethnicity on vulnerability to PTSD are identified, including psychosocial factors (racial/ethnic discrimination and alienation) and sociocultural influences (stoicism and normalization of stress, alexithymia, and fatalism). Areas in which future research is needed are indicated.
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Affiliation(s)
- A M Ruef
- National Center for Posttraumatic Stress Disorder, Boston Veterans Administration Medical Center, Massachusetts, USA
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Schlenger WE, Etheridge RM, Hansen DJ, Fairbank DW, Onken J. Evaluation of state efforts to improve systems of care for children and adolescents with severe emotional disturbances: the CASSP (Child and Adolescent Service System Program) initial cohort study. J Ment Health Adm 1999; 19:131-42. [PMID: 10121506 DOI: 10.1007/bf02521314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 1984, the National Institute of Mental Health (NIMH) began funding its Child and Adolescent Service System Program (CASSP). In this paper, we present findings from a descriptive study of the experiences of the initial cohort of states to receive CASSP grants, conceived and conducted when the projects were approaching the end of their fifth and final year of NIMH funding. Detailed case studies were conducted of each of the 10 initial cohort projects, and the findings analyzed across projects. Data were collected from three major sources: (1) existing documentation about the projects, (2) site visits to each of the projects, and (3) information from relevant secondary sources. Findings suggest that the initial cohort projects utilized a variety of strategies and encountered a variety of barriers and facilitating factors. The projects generally implemented the intended CASSP program and did so by using a variety of strategies. The projects were judged by stakeholders in their states to have influenced the service systems in their states in the intended directions: toward a more comprehensive system of care that emphasizes community-based treatment; toward better integrated, more collaborative efforts among the state agencies involved; toward a more detailed understanding on the part of system stakeholders of the mental health problems of children and adolescents who have severe emotional disturbances, and of the influence of those problems on the lives of the children and their families; and toward increased involvement by parents and other family members in the care of these children and adolescents.
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Affiliation(s)
- K N Lohr
- Health and Social Policy Division, Research Triangle Institute, North Carolina, USA
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Zatzick DF, Marmar CR, Weiss DS, Browner WS, Metzler TJ, Golding JM, Stewart A, Schlenger WE, Wells KB. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 1997; 154:1690-5. [PMID: 9396947 DOI: 10.1176/ajp.154.12.1690] [Citation(s) in RCA: 322] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Although posttraumatic stress disorder (PTSD) is a highly prevalent and often chronic condition, the relationship between PTSD and functioning and quality of life remains incompletely understood. METHOD The authors undertook an archival analysis of data from the National Vietnam Veterans Readjustment Study. The study subjects consisted of the nationally representative sample of male Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. The authors estimated PTSD at the time of the interview with the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. They examined the following outcomes: diminished well-being, physical limitations, bed day in the past 2 weeks, compromised physical health status, currently not working, and perpetration of violence. Logistic models were used to determine the association between PTSD and outcome; adjustment was made for demographic characteristics and comorbid psychiatric and other medical conditions. RESULTS The risks of poorer outcome were significantly higher in subjects with PTSD than in subjects without PTSD in five of the six domains. For the outcome domains of physical limitations, not working, compromised physical health, and diminished well-being, these significantly higher risks persisted even in the most conservative logistic models that removed the shared effects of comorbid psychiatric and other medical disorders. CONCLUSIONS The suffering associated with combat related-PTSD extends beyond the signs and symptoms of the disorder to broader areas of functional and social morbidity. The significantly higher risk of impaired functioning and diminished quality of life uniquely attributable to PTSD suggests that PTSD may well be the core problem in this group of difficult to treat and multiply afflicted patients.
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Affiliation(s)
- D F Zatzick
- Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco, USA
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Zatzick DF, Weiss DS, Marmar CR, Metzler TJ, Wells K, Golding JM, Stewart A, Schlenger WE, Browner WS. Post-traumatic stress disorder and functioning and quality of life outcomes in female Vietnam veterans. Mil Med 1997; 162:661-5. [PMID: 9339077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This investigation assessed whether current post-traumatic stress disorder (PTSD) was associated with impaired functioning in a nationally representative sample of female Vietnam veterans. METHODS Logistic models were used to determine the association between PTSD and outcome while adjusting for demographic characteristics and medical and psychiatric co-morbidities. RESULTS PTSD was associated with significantly elevated odds of poorer functioning in five of the six outcome domains; only the association between perpetration of violence in the past year and PTSD did not achieve statistical significance. After adjusting for demographics and medical and psychiatric co-morbidities, PTSD remained associated with significantly elevated odds of bed days, poorer physical health, and currently not working. CONCLUSIONS Among female Vietnam veterans PTSD is associated with a broad profile of functional impairment. The significantly increased odds of impaired functioning and diminished quality of life suggest that PTSD may be the core problem of the set of problems afflicting female Vietnam veterans.
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Affiliation(s)
- D F Zatzick
- Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco 94143, USA
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Zatzick DF, Weiss DS, Marmar CR, Metzler TJ, Wells K, Golding JM, Stewart A, Schlenger WE, Browner WS. Post-Traumatic Stress Disorder and Functioning and Quality of Life Outcomes in Female Vietnam Veterans. Mil Med 1997. [DOI: 10.1093/milmed/162.10.661] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Douglas F. Zatzick
- Robert Wood Johnson Clinical Scholars Program, 521 Parnassus Avenue, Suite C-126, Box 0903, University of California, San Francisco, CA 94143
- Veterans Affairs Medical Center, San Francisco, 4150 Clement Avenue, San Francisco, CA 94121, and Department of Psychiatry, University of California, San Francisco, CA 94143
| | - Daniel S. Weiss
- Veterans Affairs Medical Center, San Francisco, 4150 Clement Avenue, San Francisco, CA 94121, and Department of Psychiatry, University of California, San Francisco, CA 94143
| | - Charles R. Marmar
- Veterans Affairs Medical Center, San Francisco, 4150 Clement Avenue, San Francisco, CA 94121, and Department of Psychiatry, University of California, San Francisco, CA 94143
| | - Thomas J. Metzler
- Veterans Affairs Medical Center, San Francisco, 4150 Clement Avenue, San Francisco, CA 94121, and Department of Psychiatry, University of California, San Francisco, CA 94143
| | - Kenneth Wells
- Robert Wood Johnson Clinical Scholars Program, 88–201 NPI, 760 Westwood Plaza, University of California at Los Angeles, Los Angeles, CA 90024
| | - Jacqueline M. Golding
- Institute for Health and Aging, University of California, Box 0646, San Francisco, CA 94143
| | - Anita Stewart
- Institute for Health and Aging, University of California, Box 0646, San Francisco, CA 94143
| | | | - Warren S. Browner
- Veterans Affairs Medical Center, San Francisco, 4150 Clement Avenue, San Francisco, CA 94121, and Department of General Internal Medicine, University of California, San Francisco, CA 94143
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Abstract
Little is known about the mechanisms underlying emotional numbing (EN). The functional relationship between other classes of posttraumatic stress disorder (PTSD) symptoms and EN is also not well understood. In the present study, we examined the statistical predictors of EN. We hypothesized that the severity of EN would be most strongly associated with the hyperarousal symptoms rather than the avoidance symptoms of PTSD, or comorbid depression or substance abuse. This prediction was derived from psychological and biological models that posit EN to be a product of the depletion of emotional resources subsequent to chronic hyperarousal. Using hierarchical multiple regression in two separate samples of Vietnam combat veterans, we found hyperarousal symptoms to be the most robust predictor of EN. These data suggest that there is a substantive relationship between hyperarousal symptoms and EN in PTSD.
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Affiliation(s)
- B T Litz
- Boston Department of Veterans Affairs Medical Center, Medford, Massachusetts, USA
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Jordan BK, Schlenger WE, Fairbank JA, Caddell JM. Prevalence of psychiatric disorders among incarcerated women. II. Convicted felons entering prison. Arch Gen Psychiatry 1996; 53:513-9. [PMID: 8639034 DOI: 10.1001/archpsyc.1996.01830060057008] [Citation(s) in RCA: 200] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND No unbiased estimates of the rates of psychiatric disorder among women prison inmates are available. Nonetheless, available data suggest that some psychiatric disorders are prevalent in this population. The objective of the study was to determine the rates, risk factors, and outcomes of specific psychiatric disorders among women prison inmates. METHODS A virtual census of women felons (N = 805) entering prison in North Carolina was assessed using in-person interviews. Assessments were conducted for 8 disorders, using the Composite International Diagnostic Interview as the primary assessment measure. For validation purposes, one quarter of the inmates were reassessed for 2 of these disorders, using structured clinical interviews. RESULTS Inmates were found to have high rates of substance abuse and dependence and antisocial and border-line personality disorders compared with women in community epidemiologic studies. Rates among inmates were also somewhat elevated for mood disorders but not for anxiety disorders. The rate of reports of lifetime exposure to traumatic events was also high. Rates of disorder tended to be higher among white than among African American women. CONCLUSION High rates of substance abuse, psychiatric disorder, and psychological distress associated with exposure to traumatic events suggest that women in prison have a need for treatment for substance abuse and other mental health problems.
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Affiliation(s)
- B K Jordan
- Research Triangle Institute, Research Triangle Park, NC, USA
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Marmar CR, Weiss DS, Schlenger WE, Fairbank JA, Jordan BK, Kulka RA, Hough RL. Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. Am J Psychiatry 1994; 151:902-7. [PMID: 8185001 DOI: 10.1176/ajp.151.6.902] [Citation(s) in RCA: 422] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. RESULTS The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. CONCLUSIONS These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.
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Affiliation(s)
- C R Marmar
- Department of Psychiatry, University of California, San Francisco
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Jordan BK, Schlenger WE, Fairbank JA. PTSD and substance abuse. Am J Psychiatry 1993; 150:995-6. [PMID: 8494100 DOI: 10.1176/ajp.150.6.aj1506995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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39
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Schlenger WE, Jordan BK, Fairbank JA. Effects of military experience on mental health problems and work behavior. Med Care 1993; 31:470-4. [PMID: 8501994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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King DW, King LA, Fairbank JA, Schlenger WE, et al. Enhancing the precision of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: An application of item response theory. Psychol Assess 1993. [DOI: 10.1037/1040-3590.5.4.457] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jordan BK, Marmar CR, Fairbank JA, Schlenger WE, Kulka RA, Hough RL, Weiss DS. Problems in families of male Vietnam veterans with posttraumatic stress disorder. J Consult Clin Psychol 1992. [PMID: 1460153 DOI: 10.1037//0022-006x.60.6.916] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed.
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Affiliation(s)
- B K Jordan
- Center for Social Research and Policy Analysis, Research Triangle Institute, Research Triangle Park, North Carolina 27709-2194
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42
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Jordan BK, Marmar CR, Fairbank JA, Schlenger WE, Kulka RA, Hough RL, Weiss DS. Problems in families of male Vietnam veterans with posttraumatic stress disorder. J Consult Clin Psychol 1992; 60:916-26. [PMID: 1460153 DOI: 10.1037/0022-006x.60.6.916] [Citation(s) in RCA: 406] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed.
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Affiliation(s)
- B K Jordan
- Center for Social Research and Policy Analysis, Research Triangle Institute, Research Triangle Park, North Carolina 27709-2194
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43
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Jordan BK, Schlenger WE, Hough R, Kulka RA, Weiss D, Fairbank JA, Marmar CR. Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls. Arch Gen Psychiatry 1991; 48:207-15. [PMID: 1996916 DOI: 10.1001/archpsyc.1991.01810270019002] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To determine if Vietnam theater veterans were more likely than controls to have a specific psychiatric disorder other than posttraumatic stress disorder, the rates of specific psychiatric disorders were estimated using the Diagnostic Interview Schedule for national samples of veterans who served in Vietnam, other veterans of the Vietnam era, and matched civilian controls. Overall, there were few differences in rates of disorder between theater and other veterans; there were somewhat more differences between theater veterans and civilians. There were striking differences, however, in rates for most disorders, both lifetime and current, between male theater veterans with high levels of exposure to war zone stress and other male veterans or civilians. Female veterans exposed to high levels of war zone stress also had higher rates than other female respondents for several disorders.
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Affiliation(s)
- B K Jordan
- Center for Social Research and Policy Analysis, Research Triangle Institute, Research Triangle Park, NC 27709
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Abstract
While the empirical association of drinking and problem drinking to violence is well established, the etiological nature of the relationship is poorly understood. Using data collected from 1,149 convicted male felons, the acute (drinking just before the violent event) and chronic (a psychiatric diagnosis of alcohol abuse or dependence) effects of alcohol use on violence were analyzed. Logistic regression models were used to examine the relationship of acute and chronic alcohol effects to incarceration for a violent offense and arrest for a violent offense, with demographic and criminal history factors controlled. The acute effects of alcohol were found to be significantly associated with incarceration for a violent offense, but the net explanatory capacity of acute alcohol effects was not large. Chronic alcohol effects were not significantly associated with incarceration for a violent offense or arrest for a violent offense in the previous year. The findings were interpreted as being consistent with the hypothesis that alcohol effects violence directly, acting through the acute effects of use, rather than indirectly through the effects of underlying or mediating factors.
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Affiliation(s)
- J J Collins
- Research Triangle Institute, Research Triangle Park, North Carolina 27709
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45
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Taube CA, Schlenger WE, Rupp A, Whitmore RW. Validity of Medicaid household respondent reporting of ambulatory visits for mental disorders. J Econ Soc Meas 1986; 14:243-56. [PMID: 10302014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Comparison with administrative records or "best estimate file" enables an evaluation of the accuracy of household reports of mental health use in the four-State Medicaid Household Survey conducted as part of the National Medical Care Utilization and Expenditure Survey. Underreporting of probability of ambulatory mental health use ranged from 14 to 24% compared to 5 to 7% for ambulatory health visits; household estimates of number of mental health visits seemed to be more accurate than administrative records. Household reporting of provider type seemed to be very accurate for psychiatrist visits, but there seemed to be a tendency to report psychologist visits as psychiatrist visits.
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46
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Hubbard RL, Schlenger WE, Rachal JV, Bray RM, Craddock SG, Cavanaugh ER, Ginzburg HM. Patterns of alcohol and drug abuse in drug treatment clients from different ethnic backgrounds. Ann N Y Acad Sci 1986; 472:60-74. [PMID: 3467620 DOI: 10.1111/j.1749-6632.1986.tb29611.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In this paper we have sought to identify differences in alcohol consumption patterns and problems among young adult males from white, black, and Hispanic ethnic groups entering drug treatment programs. In overall consumption patterns we found results similar to those obtained in general population studies. However, about one-third of the clients in all ethnic groups could be classified as heavier drinkers (drinking at least once a week and 4 or more drinks per drinking occasion) in the period immediately prior to treatment. About one-fourth of the clients in each ethnic group consumed a daily average of 2.5 ounces of absolute alcohol. Compared with the other ethnic groups, blacks were the most likely to be abstainers and reported regular alcohol use and drunkenness at later ages. Regardless of the pattern of development, similar proportions of the clients in all ethnic groups reported heavier drinking levels by age 21-30. Consistent with the current hypotheses in the literature, whites reported much higher levels of alcohol-related problems and prior treatment. Despite having similar levels of drinking, black and Hispanic ethnic groups did not appear to recognize alcohol as a problem or to report alcohol-related problems to the extent that whites did. Examination of drug-use patterns showed great variation in the nature and extent of drug use among the three ethnic groups. Whites were distributed among the seven patterns of use. Heroin use with cocaine, marijuana, and alcohol was the predominant pattern for blacks and Hispanics. Although the patterns of drug use differed greatly, these patterns were not differentially related to alcohol consumption or alcohol-related problems within ethnic groups. On the contrary, the drug-use patterns appeared to be a stronger predictor than ethnicity of use and problems. Multiple-nonnarcotic-users reported the highest levels of alcohol consumption and the greatest numbers of alcohol-related problems. This group typically reported the highest number of alcohol-related problems. Expression of a current need for treatment and a history of prior alcohol treatment were highest for black multiple-nonnarcotic-users. Our examination of the influences of family and friends was based on a limited number of questions available in the data. Heavier drinking was reported by clients who lived with friends, had family or friends who drank regularly, or had extensive involvement in the drug-use network, including drug sales. No ethnic differences were found.(ABSTRACT TRUNCATED AT 400 WORDS)
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47
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Garfinkel SA, Schlenger WE, McLeroy KR, Bryan FA, York BJ, Dunteman GH, Friedlob AS. Choice of payment plan in the Medicare capitation demonstration. Med Care 1986; 24:628-40. [PMID: 3523067 DOI: 10.1097/00005650-198607000-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This article identifies factors that influence the choice between joining an HMO and remaining with the traditional fee-for-service system among aged Medicare beneficiaries in three communities. Sources of marketing information were found to be strongly and positively related to the decision to join the HMO. Among beneficiaries who had to switch providers to join, persons who had a prior usual source of care and those who were satisfied with the amount of paperwork required to use that source of care were less likely to enroll in the HMO. Persons who did not have to switch providers to join the HMO were more likely to enroll in the prepaid program if they were satisfied with the amount of paperwork involved in using the HMO prior to the demonstration. Differences among the three communities suggest that the barrier to HMO enrollment presented by having a prior source of care who is not affiliated with the HMO may attenuate as the number of competing HMOs in the community increases, making the medical care environment more competitive. In the community with the most HMOs, persons who already had supplemental insurance were less likely to enroll than those who did not. None of the six HMOs studied experienced adverse selection, based on pre-enrollment health status.
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48
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Taube CA, Schlenger WE, Rupp A, Whitmore RW. Validity of Medicaid Household Respondent Reporting of Ambulatory Visits for Mental Disorders. ACTA ACUST UNITED AC 1986. [DOI: 10.3233/jem-1986-14307] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carl A. Taube
- National Institute of Mental Health and Research Triangle Institute
| | | | - Agnes Rupp
- National Institute of Mental Health and Research Triangle Institute
| | - Roy W. Whitmore
- National Institute of Mental Health and Research Triangle Institute
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49
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Schlenger WE, Corder LS. Access to health care among aged Medicare beneficiaries. Natl Med Care Util Expend Surv B 1984:1-31. [PMID: 10304188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of participants' access to health care services were collected in NMCUES. These included identification of a regular source of care, several characteristics of physical access to the regular source (transportation mode, travel time, waiting room time), insurance coverage, and the existence of medically unattended conditions. The purpose of this report is to provide descriptive information about selected aspects of access to health care among noninstitutionalized elderly people who reported being covered by Medicare. The results presented are based on data collected about noninstitutionalized people in the NMCUES national household sample who: (1) were 65 years of age and over at any time during the survey year, and (2) reported being covered by Medicare Hospital Insurance, Supplementary Medical Insurance, or both during the survey year (1980). The regular source of care for three out of four (74 percent) of the elderly Medicare beneficiaries was a physician's office (including group practice or doctor's clinic), while for 9 percent the regular source was a hospital outpatient clinic, emergency room, health center, or other provider type (referred to hereafter as "clinic"). Of the elderly Medicare beneficiaries, 10 percent reported no regular source of care, and the regular source was unknown for 7 percent. Of those with no regular source of care, 80 percent identified their seldom getting sick as an important reason for having no regular source, 24 percent identified their desire to go to different places for different health care needs, 14 percent said their usual source was no longer available, and 5 percent identified their recently moving into the area as an important reason. Nearly six out of ten (59 percent) of the elderly Medicare beneficiaries who reported that their regular source was a physician's office drove themselves there, and about four out of ten (43 percent) of those who reported that their regular source was a clinic drove themselves to the clinic. On the average, people traveled nearly 10 minutes more to a clinic than to a physician's office (29 versus 20 minutes). There was little variability in reported length of travel time among the various demographic categories--e.g., men tended to travel for the same length of time as did women, black people for the same travel time as white people.(ABSTRACT TRUNCATED AT 400 WORDS)
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50
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Schlenger WE, Wadman WM, Corder LS. Health status of aged Medicare beneficiaries. Natl Med Care Util Expend Surv B 1983:1-24. [PMID: 10313517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of participants' health status were collected in NMCUES. These included measures of disability, activity limitation, illness conditions, and perceived health status. The purpose of this report is to provide preliminary descriptive information from NMCUES about selected aspects of the health status of noninstitutionalized elderly people who reported being covered by Medicare. The results presented are based on data collected about noninstitutionalized people in the NMCUES national household sample who: (1) were 65 years of age and over at any time during the survey year, and (2) reported being covered by Medicare Hospital Insurance, Supplementary Medical Insurance, or both during the survey year (1980). Of the aged Medicare beneficiaries, 37 percent reported experiencing no days on which their activities were limited for health reasons during the survey year. The average number of restricted activity days (RAD's) per year per person among all aged Medicare beneficiaries was estimated to be 31. By comparison, people under 65 years of age averaged 12 RAD's. At the beginning of the survey period, 60 percent reported that they were not limited in either their usual activity (e.g., work) or other activities (e.g., recreation) for health reasons. Men were substantially more likely than women to be limited in their activities (52 versus 31 percent). Of persons under 65 years of age, 94 percent reported no activity limitation. Of aged Medicare beneficiaries, 7 percent reported having no illness conditions during the survey year, while 23 percent reported seven or more illness conditions. Only 5 percent reported having one or more illness conditions for which they had not sought medical attention. The average number of conditions per person during the year was 4.4. People under 65 years of age averaged 2.9 illness conditions. The health of more than one-fourth (26 percent) of the elderly Medicare beneficiaries was judged to be excellent relative to other people of the same age, while the health of one out of eight people (12 percent) was judged to be poor.(ABSTRACT TRUNCATED AT 400 WORDS)
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